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Lung volume reduction surgery- fruitful or foolish?
ABSTRACTS
Heart, Lung and Circulation (2015) 24S1, e7–e11 1443-9506/04/$36.00
MINI ORAL SESSION 1 – Thoracic & Paediatric Cardiac Lung volume reduction surgery- fruitful or foolish? Matilda Anderson *, Julian Gooi, Lynda Holsworth, Greg Snell, Helen Whitford, Glen Westall, David McGiffin Department of Cardiothoracics/Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia * Corresponding author. Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a debilitating disease that greatly affects the quality of life of its sufferers. It is estimated that 5.6% of the Australian population suffer from Stage II to IV COPD. End-stage COPD carries a high 12-month mortality and often the only treatment option is lung transplantation. Lung volume reduction surgery (LVRS) is an alternative that can offer patients with upper-lobe predominant COPD improvement in respiratory function testing and quality of life. We present the experiences and outcomes of a single institution performing bilateral LVRS for patients with severe COPD. Methods: Between September 2007 and October 2013, 25 patients underwent bilateral LVRS via a 3-port bilateral sequential VATS technique at a single institution in Melbourne, Australia. All patients underwent detailed pre-operative investigations and a rehabilitation program. Preoperative spirometry was performed and compared with post-operative results. Details of patients’ post-operative course were recorded.
Results: 25 patients underwent bilateral LVRS over the defined time period. 5 patients underwent separate right and left side procedures. Thirty-day mortality was 4% (1 in 25 patients). Out of 30 admissions, mean hospital stay was 19 days (range 6-45), with 56% requiring ICU admission. Of patients with improved FEV1 post operatively, the mean improvement was 30%. 5 patients showed reduction in FEV1. Complications included prolonged air leak >7 days (43%), atrial arrhythmias (17%), and return to theatre (20%). Two
patients have gone on to have bilateral sequential lung transplantation. Discussion: LVRS remains a difficult yet viable option for selected patients with severe COPD. Our results show that patients can have significant improvements in FEV1%, however their post-operative course can be challenging to patients and their treating units. Despite recent advances in endobroncial LVRS techniques, surgical LVRS remains the gold standard treatment for appropriate patients. Future research at our institutions will include establishment of an End-Stage COPD Unit and a detailed database to facilitate long-term follow up. http://dx.doi.org/10.1016/j.hlc.2014.12.018 Treatment of octogenarians with lung cancer: A single centre audit of treatments and outcomes Background: Because of an ageing population and the high prevalence of lung cancer a larger number of octogenarians present with lung cancer. Objectives: Document the incidence, stage at presentation and therapy offered to octogenarians with non-small cell lung cancer (NSCLC) over three years and compare to the whole lung cancer population. Methods: A retrospective analysis of patients with NSCLC managed via a lung cancer multidisciplinary team at Canterbury District Health Board between June 2009 and December 2012. Follow-up data at least one year following presentation was analysed. Results: The study population comprised 124 octogenarians (mean 83.7 years) of which 54 (42%) were female; they presented with adenocarcinoma 48 (38.7%), squamous cell 35 (28.2%) and without tissue diagnoses 41 (33.1%). Stage I and II lung cancer was found in 43 (34%) patients. Surgical resection ensued in six (4.8%), radiotherapy with curative intend in 20 (16.1%), non-curative treatment options in 98 (79%) and compared to 112 (14.8%), 118 (15.6%) and 529 (69%) of the 759 patients in the whole cohort with NSCLC. All of the surgical group and 15 (75%) in the radiotherapy group of octogenarians were alive at 1 year; which is comparable to the whole cohort, where all patients of the surgical group and 78 (66.1%) of the radiotherapy group were alive at 1 year. Conclusion: Octogenarians who undergo radiotherapy or surgery with curative intent have an excellent one year survival. Because all patients were alive at one year following surgical resection, we conclude that surgery seems to be aviable treatment option in octogenarians, which may be underutilised. http://dx.doi.org/10.1016/j.hlc.2014.12.019
Heart, Lung and Circulation (2015) 24S1, e7–e11 1443-9506/04/$36.00
MINI ORAL SESSION 1 – Thoracic & Paediatric Cardiac Lung volume reduction surgery- fruitful or foolish? Matilda Anderson *, Julian Gooi, Lynda Holsworth, Greg Snell, Helen Whitford, Glen Westall, David McGiffin Department of Cardiothoracics/Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Australia * Corresponding author. Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a debilitating disease that greatly affects the quality of life of its sufferers. It is estimated that 5.6% of the Australian population suffer from Stage II to IV COPD. End-stage COPD carries a high 12-month mortality and often the only treatment option is lung transplantation. Lung volume reduction surgery (LVRS) is an alternative that can offer patients with upper-lobe predominant COPD improvement in respiratory function testing and quality of life. We present the experiences and outcomes of a single institution performing bilateral LVRS for patients with severe COPD. Methods: Between September 2007 and October 2013, 25 patients underwent bilateral LVRS via a 3-port bilateral sequential VATS technique at a single institution in Melbourne, Australia. All patients underwent detailed pre-operative investigations and a rehabilitation program. Preoperative spirometry was performed and compared with post-operative results. Details of patients’ post-operative course were recorded.
Results: 25 patients underwent bilateral LVRS over the defined time period. 5 patients underwent separate right and left side procedures. Thirty-day mortality was 4% (1 in 25 patients). Out of 30 admissions, mean hospital stay was 19 days (range 6-45), with 56% requiring ICU admission. Of patients with improved FEV1 post operatively, the mean improvement was 30%. 5 patients showed reduction in FEV1. Complications included prolonged air leak >7 days (43%), atrial arrhythmias (17%), and return to theatre (20%). Two
patients have gone on to have bilateral sequential lung transplantation. Discussion: LVRS remains a difficult yet viable option for selected patients with severe COPD. Our results show that patients can have significant improvements in FEV1%, however their post-operative course can be challenging to patients and their treating units. Despite recent advances in endobroncial LVRS techniques, surgical LVRS remains the gold standard treatment for appropriate patients. Future research at our institutions will include establishment of an End-Stage COPD Unit and a detailed database to facilitate long-term follow up. http://dx.doi.org/10.1016/j.hlc.2014.12.018 Treatment of octogenarians with lung cancer: A single centre audit of treatments and outcomes Background: Because of an ageing population and the high prevalence of lung cancer a larger number of octogenarians present with lung cancer. Objectives: Document the incidence, stage at presentation and therapy offered to octogenarians with non-small cell lung cancer (NSCLC) over three years and compare to the whole lung cancer population. Methods: A retrospective analysis of patients with NSCLC managed via a lung cancer multidisciplinary team at Canterbury District Health Board between June 2009 and December 2012. Follow-up data at least one year following presentation was analysed. Results: The study population comprised 124 octogenarians (mean 83.7 years) of which 54 (42%) were female; they presented with adenocarcinoma 48 (38.7%), squamous cell 35 (28.2%) and without tissue diagnoses 41 (33.1%). Stage I and II lung cancer was found in 43 (34%) patients. Surgical resection ensued in six (4.8%), radiotherapy with curative intend in 20 (16.1%), non-curative treatment options in 98 (79%) and compared to 112 (14.8%), 118 (15.6%) and 529 (69%) of the 759 patients in the whole cohort with NSCLC. All of the surgical group and 15 (75%) in the radiotherapy group of octogenarians were alive at 1 year; which is comparable to the whole cohort, where all patients of the surgical group and 78 (66.1%) of the radiotherapy group were alive at 1 year. Conclusion: Octogenarians who undergo radiotherapy or surgery with curative intent have an excellent one year survival. Because all patients were alive at one year following surgical resection, we conclude that surgery seems to be aviable treatment option in octogenarians, which may be underutilised. http://dx.doi.org/10.1016/j.hlc.2014.12.019